How to Fix ObamaCare and End the Shutdown

Real socialized medicine would solve some complications and make it harder for Republicans to protest.
Ben Franklin surgical mask


Say, wouldn’t this all be easier if we’d simply passed a single-payer health insurance program?

We’ve spent several weeks now watching, first, the House of Representatives implode as it tried—and repeatedly failed—to force either an end to ObamaCare or, short of that, an end to parts of ObamaCare. (On Tuesday, it was the part that ensures women’s access to birth control that Republicans seemed most to want to end.)  That failure might be satisfying, except that the health insurance exchanges created by ObamaCare finally went online—and gave every appearance of also imploding.

It’s a bad situation all around, but it’s one that probably could’ve been mitigated considerably with a real government takeover of the America’s healthcare, instead of the complicated and frankly messy half-job we’ve seen so far. A single-payer health insurance program—everybody pays a health insurance tax, everybody gets health insurance from the government—would’ve solved many of the problems we see before us now.

What problems would it have solved?

• The fight over the mandate: Lots of people object to the idea that government can make them buy health insurance (i.e. “the mandate”). Lots of people also object to taxes, but nobody really questions whether the government can tax you or not. In fact, the only reason the mandate survived Supreme Court scrutiny was because John Roberts decided it was really a tax by another name. Crazy as this sounds, a health care tax probably would’ve gone down easier than a health insurance mandate.

• The complications: The Affordable Care Act itself is thousands of pages long; regulations issued to make it work amount to thousands more pages. Employers provide insurance, except for the ones who don’t, in which case private individual buy their own insurance, except for the ones who can’t, who will get subsidies (unless they don’t) and those who can will buy them from state exchanges, except in states that have refused to create them. Add in all the other factors that create price differences in the insurance. Throw in new regulations about who is to be covered—young adults, people with pre-existing conditions—and you’ve got a lot of moving parts. As any engineer can tell you: The more moving parts, the greater the chance of breakdown.

Under single-payer, you pay a tax, you get insurance. Simpler.

• The religious freedom debate: Because the system remains largely reliant on private insurance, employers complain about new rules requiring them to pay for an employee’s birth control. But employees shouldn’t have to hope their employer is an atheist or Episcopalian in order to ensure their reproductive health is taken care of. A single government program would’ve removed the employer—and his conscience—as middlemen in the process.

(Some folks might object to their taxes paying for birth control, as well. All I can say is: Mennonites are religiously opposed to war, yet most still pay taxes that go to support the Department of Defense. You don’t like it, but government funds lots of stuff that’s disliked by somebody. That’s the price of pluralistic democracy. Everybody seems to survive.)

Jobs: There’s some evidence that employers have cut back jobs or delayed hiring to avoid the requirements of ObamaCare: Again, if everybody’s paying the tax—and the burden of health insurance lifted from employers and given to government—then it’s not a problem for any company. And no company puts itself at a competitive disadvantage by not firing workers. Everybody wins.

(My conservative and libertarian friends argue for a system in which everybody buys their own insurance and then drive down costs for medical care because they’re aware of how much care costs and budget accordingly. But it’s worth remembering that government health care programs started in the first place—Medicare, in 1964—because the market at that time had a pretty free hand to determine the cost of care. And that cost was too high for many senior citizens of the time; only one in eight had health insurance. Gubmint medicine may not be perfect, but it arose in response to a genuine need that markets weren’t solving.)

Now you can argue that a single-payer program is still a government takeover—too much so!—and thus socialist and thus evil, and more power to you. But at this point, wouldn’t a single-payer plan be more libertarian than the Affordable Care Act? Wouldn’t it be less intrusive and leave a lighter footprint in lots of people’s lives, while still expanding health care access to millions of people who need it? That’s what this is all supposed to be about, right?